Frequency of Different Ligament Tears in Knee Injury On Magnetic Resonance Imaging

: Background: MRI had been useful in the diagnosis of ligament injuries and the tears were detected by non-invasive procedure. Objective: To determine the frequency of different ligament tears in knee injury on Magnetic Resonance Imaging. Methods: A descriptive cross-sectional was conducted with the sample size of 206 patients of both genders by selecting the convenient sampling from Ghurki Trust Teaching Hospital, Lahore. Out of 206 patients, 157 were males while 49 were females. Data was analyzed with the help of SPSS version 24. The results were derived by mean, frequency and standard deviation. Results: Findings shows that among 206 patients, with in age limit of 12 years to 70 years. 157(76.2%) were males and 49(23.7%) were female while 96(46.6%) were presented with ACL tear, 19(9.2%) were presented with PCL tears, 51(25.7%) were presented with MCL tears, 33(16.0%) patients were presented with LCL tears and all of these 206 patients were suffering from pain. Conclusion: We concluded that males are more prevalent than females and in this population the incidence of ACL tears is more than other ligament tears. Hence, ACL is proved to be the most injured ligament.


Introduction
The largest joint in the body is knee joint which consist of vast network of ligaments and muscles. The most frequently injured joint in the body is knee joint. The presence of ligament provide greater stability to the knee joint 1 . Anterior cruciate ligament is the main component in the knee joint because it withstand anterior and tibial movement and rotational loads and often injured structure and does not recover when torn 2 . Due to higher prevalence during sporting exertion, Anterior Cruciate Ligament injury is significant harm to knee joint and also leave the subject with immobilize joint during physical exertion 3 . In the united states ACL injuries occur between 100000 to 200000 per year this shows that ACL is the most frequently injured ligament and mostly soccer players are at high risk of ACL injuries(53% of total) with athletes and skiers are also prone to ACL injuries 4 .The posterior cruciate ligament is known to be an intra-articular extra-synovial structure due to synovial capsule that lines the ligament ,its length is about 32-38mm with an area of 11mm 2 ,with its midstuff is three times smaller than the bony insertion of posterior cruciate ligament 5 . Posterior Cruciate Ligament injuries are minor quotidian than other knee ligament injuries, but they narrative for significant morbidity 6 .Superficial Medial collateral ligament is based on two attachment one is attachment of femur and the other is attachment of tibia and medial collateral ligament is also called tibial Collateral ligament and dense medial side of the joint capsule which is deep as compared to the superficial medial collateral ligament form the deep medial collateral ligament which comprises of meniscofemoral and meniscotibial constituent 7 .When intact, the superficial medial collateral ligament is the foremost immobile stabilizer to valgus deformity as compared to deep medial collateral ligament although when superficial medial collateral ligament is damaged, the major role of deep medial collateral ligament is to act as stabilizer in providing greater flexion angles and posteromedial capsule helps in extension 8 .The anatomy of lateral sides of knee is complicated pattern of stationary (ligament) and mobile (tendons and muscles) stabilizing framework and the entanglement of anatomy is because of progressive changes in the anatomic affiliation of fibular head , the popliteal tendon and the biceps femoris muscle, the role of the ligament is kind of mosaic and there essential act is to prevent abnormal motion 9 . For the evaluation of acute knee ligament tears, Magnetic resonance imaging scan have been seen to be greatly effective 10 .When Magnetic resonance imaging implemented right after the injury it shows to be the most accurate imaging technique for the knee and also helps those patients who need further treatment 11 . Magnetic Resonance Imaging has immense effect on musculoskeletal scanning to often visualize the knee and signifies in those with suspicious damage of the menisci and cruciate ligament, Magnetic resonance imaging aids in evaluating the knee injuries due to its high soft tissue resolution 12 .
In this study we had investigated the accuracy of MRI in those patients suffering with ligament (ACL, PCL, LCL and MCL) tears of the knee joint.

Methods
In this descriptive cross sectional study, 206 patients with history of pain were included all the patients had been collected from Ghurki Trust Teaching Hospital Lahore. After informed consent data were collected through 0.35 Tesla Hitachi machine. Patients having pain and with age ranging from 12 to 70 years were included. Tears of Anterior cruciate ligament, Posterior cruciate ligament, lateral collateral ligament and medial collateral ligaments were identified. T1, T2, proton density, axial and sagittal sequences were used to obtained images of knee ligaments.

Discussion
In the current study, it is depicted that out of total 206 patients whose age ranges from 12 years to 70 years were presented with pain. Out of these 206 patients, 157(76%) patients were males and 49(23.7%) were females. Among these 96(46.6%) were presented with ACL tears out of which 86(89.5%) were males and 10(10.41%) were females. Males showed increased incidence than females in ACL tears. These findings are similar to the study conducted by Singh Ap et.al which shows that total 75 patients were included out which 50(66.6%) appears to be males and the rest 25(33.3%) were females. ACL tears were appeared in 36(48%) patients. Males are shown to be more prevalent than females 1 . Current results were compared with similar study performed by Choi WR et.al in 2019. Out of 148 patients with anterior cruciate ligament rupture, 145 patients injured, among them 41 patients were found to be females and 107 patients were male. This result also described that males are more sufficiently affected than females 13 . Similarly result of previous study performed by Selcan Koc in 2019, according to their study they took 102 patients out of which 46 (45.1%) patients had anterior cruciate ligament injuries 14 .
This study showed that out of total 206 patients who clinically presented with pain19 (9.2%) patients had PCL tears among which 18(94.7%) were Males and 1(5.2%) was female. Males are greatly affected than females. These findings are similar to the results of study conducted in 2007 by Laprade et.al. In their study they took 187 subjects among these 11(5%) had PCL tears 10 . We correlate our results with a study conducted by JS. Grover which shows that they take 610 patients. Out of these patients 250(40.9%) were appeared to be females and 360(59.0%) were appeared as males. The age of the patients they have taken fall between 14 years to 86 years with the mean age appears to be 36 years. They illustrate that PCL injury occurs in 11(1.80%) patients. According to their study ACL is more frequently injured than PCL tears. A study was conducted to determine the frequency of different ligaments tear of knee joint 15 .
The present cases of study showed 51(24.8%) were presented with MCL tears among which 38(74.5%) were males and the rest 13(25.4%) were females. According to gender wise distribution males were dominant as compared to females. While a study conducted by Singh Ap et.al, showed 13(17%) patients were presented with MCL tears 1 . The results are also compared with the study performed by Lundblad et.al which showed that they had taken 4364 football players from 51 teams. Out of these players 130(3%) presented with MCL injuries 16 .
According to the present study, 33(16%) patients were presented with LCL tears among which 30(90.9%) were found to be Males and 3 (9.09%) were females. Similar results were related to the study by Singh Ap et.al during June 2018, which depicted that 2 (2.6%) patients were presented with LCL tears, the age group, which is mostly, affected range from 21 to 40 years, and the least affected group was 61 to 80 years 1 . This finding is also similar with the study conducted in 2007 by Laprade et.al, which shows that out of 187 subjects which were taken for study 4(2.1%) subjects had LCL tear 10 .

Conclusion
We concluded that males are more prevalent than females and in this population the incidence of ACL tears is more than other ligament tears. Hence, ACL is proved to be the most injured ligament.